| NPI | 1952751760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036149776) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.069035) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-02-02 |